Provider Demographics
NPI:1154411726
Name:PARHAM, THEORTRES (LPE)
Entity type:Individual
Prefix:
First Name:THEORTRES
Middle Name:
Last Name:PARHAM
Suffix:
Gender:M
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CHERRY STREET
Mailing Address - Street 2:SUITE 508
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342
Mailing Address - Country:US
Mailing Address - Phone:870-338-7546
Mailing Address - Fax:
Practice Address - Street 1:422 N SEBASTIAN
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-1935
Practice Address - Country:US
Practice Address - Phone:870-572-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR87-11E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health